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Anemia and Red Blood Cell Abnormalities in HIV-Infected and HIV-Exposed Breastfed Infants: A Secondary Analysis of the Kisumu Breastfeeding Study.

Odhiambo C, Zeh C, Ondoa P, Omolo P, Akoth B, Lwamba H, Lando R, Williamson J, Otieno J, Masaba R, Weidle P, Thomas T, KiBS Study Te - PLoS ONE (2015)

Bottom Line: Anemia results in increased morbidity and mortality, underscoring the need to better understand its pathophysiology amongst HIV-exposed and infected children in sub-Saharan Africa, the region where most infant HIV exposure and infections occur.The proportion of children with anemia significantly increased after the breastfeeding period in both HIV-infected and HIV-uninfected children with higher proportion among HIV-infected children compared to HIV-uninfected children (RR: 1.72; CI: 1.22-2.44, p = 0.002).A relatively lower proportion of children with severe anemia during the breastfeeding period suggest that exposure to mother's triple antiretroviral combinations through breast milk, posed minimal risk of hematologic toxicity.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.

ABSTRACT

Background: Anemia results in increased morbidity and mortality, underscoring the need to better understand its pathophysiology amongst HIV-exposed and infected children in sub-Saharan Africa, the region where most infant HIV exposure and infections occur.

Methods: This analysis used samples obtained from children in the Kisumu Breastfeeding Study (KiBS). KiBS was a longitudinal phase IIB, open-label, one-arm clinical trial, designed to investigate the safety, tolerability and effectiveness of a maternal triple-antiretroviral (ARV) regimen for prevention of mother-to-child transmission (PMTCT) of HIV, during late pregnancy and early infancy while breastfeeding. Blood samples from 482 children were obtained at birth, 2, 6, 10 and 14 weeks and 6, 9, 12, 18 and 24 months. Severity of anemia was graded using the NIH Division of AIDS (DAIDS) toxicity tables. We describe the proportion of children with anemia and anomalies in red blood cell parameters at various time points over 24 months and compare rates of anemia between HIV-infected and HIV-uninfected children and by mothers' ARV regimen and infant malaria infection.

Results: The proportion of children with anemia significantly increased after the breastfeeding period in both HIV-infected and HIV-uninfected children with higher proportion among HIV-infected children compared to HIV-uninfected children (RR: 1.72; CI: 1.22-2.44, p = 0.002). Maternal triple-antiretroviral regimen was not associated with infant anemia (p = 0.11). There was no significant difference in mean hemoglobin between HIV-uninfected children with and without malaria at each time point except at 24 months.

Conclusion: A relatively lower proportion of children with severe anemia during the breastfeeding period suggest that exposure to mother's triple antiretroviral combinations through breast milk, posed minimal risk of hematologic toxicity.

No MeSH data available.


Related in: MedlinePlus

Comparison of mean A) hemoglobin concentration and B) RBC count by malaria infection status and mean C) hemoglobin concentration and D) RBC count by mother’s triple-antiretroviral prophylaxis regimen in children, Kisumu Breastfeeding Study, Kisumu, Kenya, July 2003- February 2009.(* p<0.05). HIV+ Malaria + omitted from graphs (2A and 2B) because of small sample size.
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pone.0141599.g002: Comparison of mean A) hemoglobin concentration and B) RBC count by malaria infection status and mean C) hemoglobin concentration and D) RBC count by mother’s triple-antiretroviral prophylaxis regimen in children, Kisumu Breastfeeding Study, Kisumu, Kenya, July 2003- February 2009.(* p<0.05). HIV+ Malaria + omitted from graphs (2A and 2B) because of small sample size.

Mentions: An infant was only considered malaria-infected at the particular visit with documented asexual stage parasitemia. Co-morbid status of the infants in this analysis is summarized in Table 2. HIV-1-uninfected children with malaria had lower mean hemoglobin concentration than HIV-1-uninfected children without malaria at each timepoint after 14 weeks of age (Fig 2A), though none were significantly different (p>0.05). A similar observation was made between HIV-1-infected children without malaria and HIV-1-uninfected children without malaria except at the 24 month time point (9.4g/dL versus 10.2g/dL; p = 0.02). The mean red blood cell counts for the HIV-1-uninfected children with malaria versus without malaria were not significantly different throughout the 24 months follow up (Fig 2B). The mean red blood cell counts of HIV-1-infected children without malaria were significantly lower than in HIV-1-uninfected children with malaria at 18 months (p≤0.01) and 24 months (p≤0.01) of age. The number of HIV-1-infected children with malaria was too small (n = 7) to allow for meaningful comparisons of hematologic indices by age with children in other categories of HIV/malaria status.


Anemia and Red Blood Cell Abnormalities in HIV-Infected and HIV-Exposed Breastfed Infants: A Secondary Analysis of the Kisumu Breastfeeding Study.

Odhiambo C, Zeh C, Ondoa P, Omolo P, Akoth B, Lwamba H, Lando R, Williamson J, Otieno J, Masaba R, Weidle P, Thomas T, KiBS Study Te - PLoS ONE (2015)

Comparison of mean A) hemoglobin concentration and B) RBC count by malaria infection status and mean C) hemoglobin concentration and D) RBC count by mother’s triple-antiretroviral prophylaxis regimen in children, Kisumu Breastfeeding Study, Kisumu, Kenya, July 2003- February 2009.(* p<0.05). HIV+ Malaria + omitted from graphs (2A and 2B) because of small sample size.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4631368&req=5

pone.0141599.g002: Comparison of mean A) hemoglobin concentration and B) RBC count by malaria infection status and mean C) hemoglobin concentration and D) RBC count by mother’s triple-antiretroviral prophylaxis regimen in children, Kisumu Breastfeeding Study, Kisumu, Kenya, July 2003- February 2009.(* p<0.05). HIV+ Malaria + omitted from graphs (2A and 2B) because of small sample size.
Mentions: An infant was only considered malaria-infected at the particular visit with documented asexual stage parasitemia. Co-morbid status of the infants in this analysis is summarized in Table 2. HIV-1-uninfected children with malaria had lower mean hemoglobin concentration than HIV-1-uninfected children without malaria at each timepoint after 14 weeks of age (Fig 2A), though none were significantly different (p>0.05). A similar observation was made between HIV-1-infected children without malaria and HIV-1-uninfected children without malaria except at the 24 month time point (9.4g/dL versus 10.2g/dL; p = 0.02). The mean red blood cell counts for the HIV-1-uninfected children with malaria versus without malaria were not significantly different throughout the 24 months follow up (Fig 2B). The mean red blood cell counts of HIV-1-infected children without malaria were significantly lower than in HIV-1-uninfected children with malaria at 18 months (p≤0.01) and 24 months (p≤0.01) of age. The number of HIV-1-infected children with malaria was too small (n = 7) to allow for meaningful comparisons of hematologic indices by age with children in other categories of HIV/malaria status.

Bottom Line: Anemia results in increased morbidity and mortality, underscoring the need to better understand its pathophysiology amongst HIV-exposed and infected children in sub-Saharan Africa, the region where most infant HIV exposure and infections occur.The proportion of children with anemia significantly increased after the breastfeeding period in both HIV-infected and HIV-uninfected children with higher proportion among HIV-infected children compared to HIV-uninfected children (RR: 1.72; CI: 1.22-2.44, p = 0.002).A relatively lower proportion of children with severe anemia during the breastfeeding period suggest that exposure to mother's triple antiretroviral combinations through breast milk, posed minimal risk of hematologic toxicity.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.

ABSTRACT

Background: Anemia results in increased morbidity and mortality, underscoring the need to better understand its pathophysiology amongst HIV-exposed and infected children in sub-Saharan Africa, the region where most infant HIV exposure and infections occur.

Methods: This analysis used samples obtained from children in the Kisumu Breastfeeding Study (KiBS). KiBS was a longitudinal phase IIB, open-label, one-arm clinical trial, designed to investigate the safety, tolerability and effectiveness of a maternal triple-antiretroviral (ARV) regimen for prevention of mother-to-child transmission (PMTCT) of HIV, during late pregnancy and early infancy while breastfeeding. Blood samples from 482 children were obtained at birth, 2, 6, 10 and 14 weeks and 6, 9, 12, 18 and 24 months. Severity of anemia was graded using the NIH Division of AIDS (DAIDS) toxicity tables. We describe the proportion of children with anemia and anomalies in red blood cell parameters at various time points over 24 months and compare rates of anemia between HIV-infected and HIV-uninfected children and by mothers' ARV regimen and infant malaria infection.

Results: The proportion of children with anemia significantly increased after the breastfeeding period in both HIV-infected and HIV-uninfected children with higher proportion among HIV-infected children compared to HIV-uninfected children (RR: 1.72; CI: 1.22-2.44, p = 0.002). Maternal triple-antiretroviral regimen was not associated with infant anemia (p = 0.11). There was no significant difference in mean hemoglobin between HIV-uninfected children with and without malaria at each time point except at 24 months.

Conclusion: A relatively lower proportion of children with severe anemia during the breastfeeding period suggest that exposure to mother's triple antiretroviral combinations through breast milk, posed minimal risk of hematologic toxicity.

No MeSH data available.


Related in: MedlinePlus